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The large intestine/colon is about ___ long and begins in the lower right side where the ___ joins the ____
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How does the large intestine/colon travel
Up the ascending colon, crosses obliquely left at the hepatic flexure travels across the transverse colon, then turns at the splenic flexture to descend down the descending colon into the pelvis
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At the brim of the pelvis, the descending colon makes an S shaped curve called the _____ then becomes the ____
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The rectum lies next to the
sacrum
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The rectum is firmly attached to the ____ by the peritoneum and ends about 2 inches below the tip of the _____ where it becomes the anal canal
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The _____ is formed by the lsat 2-3 inches of the large intestine
anal canal
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the anal canal is guarded by 2 spincters
internal and external anal sphincters
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Instead of villi like the small intestine, the large intestine is made up of several pouches called
Hausta
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Many ____ inhabit the colon and can break down some of the substances that escape the actions of enzymes
bacteria
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Although the large intestine has little to no digestive functions, is serves to ____ and ____ from the remaining chyme and forms and stores the ____
- reabsorbs water
- electrolytes
- feces
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Rectal CA is ranked ___ in the US for men and women in incidence and ____ for overall death
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What is the peak age for rectal ca
50 or older
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What are causes for rectal ca
- High fat diet
- low fiber diet
- obesity
- smoking
- alcohol
- low activity
- familial
- polyposis
- chronic ulcerative colitis
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Whar are symptoms of rectal ca
- # 1 BLOOD IN STOOL
- rectal bleeding
- change in pooing
- pencil poo
- tenesmus (spasms)
- N&V
- obstruction
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How is rectal ca detected
- Physical exam
- radiographic with contrast
- endoscopic
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What determines the size, mobility, location from the anal verge and rectal wall involvement with rectal ca
- Digitla exam (finger)
- Proctosigmoidoscopy
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What tests are done to evaluate metastatic disease of rectal ca
- chest xray
- CT
- MRI
- PET/CT
- lab studies
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What tumor marker will rise if you have rectal ca
- CEA
- carcinoembryonic antigen
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What % of lesions are adenocarcinoma if large intestinal ca
90-95%
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How is rectal ca staging done
TNM or Dukes
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What route of spread does rectal CA take
- Direct ( penetrates bowel wall)
- lymphatic
- blood
- peritoneal seeding
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In rectal CA if the tumor penetrates the sub mucosal layer, which nodes are affected?
- In an orderly fashion starting with
- perirectal
- internal iliacs
- common iliacs
- paraaortic
- scv
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What is the #1 met for rectal CA
LIVER
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For rectal ca, which surgery option will save the sphincter
- Low anterior resection
- 6-12 cm from the verge
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Which surgery option for rectal ca will not save the sphincter
- abdominoperineal resection APR
- distal 5 cm
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Which chemo drugs are used with rectal ca
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If chemo is used to treat rectal ca with radiation which drugs are used
- 5FU
- leucovorin
- FOLFOX
- FOLFIRI
- ERBITUX
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What is the 5 year survival rate for rectal ca
25%
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Which radiation technique is used for rectal ca
- 3 or 4 field technique
- AP, PA, RT, LT lateral
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For rectal CA what is the field design for AP/PA
- Top- L4-L5 interspace
- Bottom- bottom of obturator foramina or 3-5 cm below tumor
- Lateral- 2cm lateral to pelvic brim and inlet
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For rectal CA what is the field design ofr Rt-LT laterals
- Top- L4-L5 interspace .
- Bottom- bottom of obturator foramina or 3-5 cm below tumor
- Anterior- Anterior edge of femoral head
- Posterior- 2cm behind sacrum
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What are different ways to simulate a patient to treat for rectal ca
- Supine or prone but prone will allow for gluteal fold reduction
- full bladder allows you to save the small bowell
- empty bladder
- vaginal marker
- contrast
- wire scar for anal verge
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What are external beam doses for rectal ca
4500 cGy to large field and 540-1440 cGy boost which you add to the 4500
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For rectal CA what is the IORT dose
1000-2000 cGy single fraction
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What are some acute side effects when treating rectal ca
- small bowel toxicites
- diarrhea
- cramps
- bloatin
- proctitis
- bloody or mucus discharge
- dysuria
- leukopenia and thrombocytopenia
- moist desquamation
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What are chronic side effects for treating rectal ca
- persistent diarrhea
- increased bowel frequency
- proctitis
- urinary incontinence
- bladder atrophy
- enteritis
- adhesions
- obstructions
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Cancers of the anus occur more frequently in
women
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Large bowel cancers are _____% of all cancers
1-2%
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What is the median age for anal ca
60
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What age does the incidence for men to increase for anal ca and why
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How long is the anus
3-4 cm long
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What type of cells are in the anus
- columnar epithelium (adenocarcinoma)
- dentate line
- squamous cell
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What are the clinical presentation for anal ca
- rectal bleeding
- pain
- change in pooing
- feeling a mass
- discharge
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How is anal ca detected
- physical
- anoscopy
- protoscopic exam
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What is the pathology for anal ca
80% are squamous cell
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How is staging done for anal ca
TNM and based on size and depth of tumor
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How are anal ca tumors spread and which nodes are affected
- direct or lymphatics
- above the dentate line (internal iliac)
- below the dentate line (inguinal nodes)
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What treatment is used for anal ca
- Radiation and/or chemo
- surgery is reserved for salvage only
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What are the chemo drugs used for anal ca
5 FU and mitomycin C
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What are treatment fields for anal ca
AP/PA of 4 field technique with electrons to the inguinal nodes (these are a very superficial treatment)
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For anal ca, if using radiation alone, what is the dose
6000-6500 cGy boost/shrinking field is 4500 cGy
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For anal ca, if doing radiation and chemo, dose is
4500 cGy with boost/shrinking field s 5940-6940 cGy
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What are the side effects for treating anal ca
- moist desquamation
- N&V
- diarrhea
- bone marrow suppression
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Which organs are at risk when treating anal ca
- bladder
- small bowel
- femoral heads
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